An Interview with Pei Fen Yan

by Molly Greacen, Dipl Ac, Dipl CH

Dr. Pei Fen Yan lives in Boulder and practices Chinese medicine with her husband, Dr. Yong Liu. Pei Fen practiced 16 years in China as an MD, OB/GYN before coming to the US in 1984. She is a delightful person, and was very open with me in sharing some of her experience with fellow Colorado practitioners.

Molly: Pei Fen, please tell me a little about your training and experience working in China.

Pei Fen: I trained in the Shu Hu Tzu Medical School in western China from 1963 to 1968. It was a combination of Chinese medicine and western medicine. At that time the government was paying a lot of attention to herbal medicine. I worked first as a midwife in the countryside, delivering babies at home and doing internal medicine. We worked very hard under the Communist government, but we were able to provide care for many people, both rich and poor. From 1973 to 1984, I worked in the Shaolin Hospital in the Hunan Province in the OB/ GYN department. There were 200 beds total and the OB/GYN ward had 50. There I used both western and Oriental medicine, including acupuncture, acupressure, herbs, moxa, western medicines, and surgery, (“the knife and the needle”). I also worked in the lung and liver departments.
I came to the US in 1984 with my husband. The first few years my English was very poor. I studied English and worked other jobs to improve my language. I worked very closely with lay midwives and also helped out at the Boulder Valley Women’s Health Center for a few months. I wanted to understand healthcare in America, to know what diseases were prevalent here. Working with the midwives, doing prenatal and delivery and postnatal helped me learn about American culture and lifestyle. Healthcare is quite different here in the West. Now I see private patients, doing OB/GYN, with acupuncture and herbal medicine. Every two to three years, I go back to China to study more. OB/GYN is very complex and there are many doctors to study with. They love to teach American people, because they want to see Chinese medicine spread all over the world. Chinese are more open now.

How are American women different from Chinese women?

In my generation in China, most women married earlier and stayed in the home and obeyed their husbands. Here women have so much freedom. They have earlier and more frequent sex, while Chinese women in my generation didn’t have sex until after marriage American teenagers enjoy sex too early, before they have knowledge of how to take care of themselves. Here most women struggle a lot with their lives and relationships...Divorce is easy and you see a lot of liver stress. Liver is a very important organ. It stores the blood and it lifts the chi, so when the liver is stressed it leads to emotional problems. American women have more liver problems than Chinese women . In the US, women have equal rights, get the same education and want the same jobs as men. They enjoy their work. In my generation in China, most women stayed in the home and obeyed their husbands. I had an unusual upbringing with my grandmother and in a family of artists, so it was easy for me to go to medical school and even to do dancing and swimming even though this was not popular for girls. Most traditional Chinese women’s lives look easier than American women. They don’t have the goals to go to medical or law school. They don’t have the same struggles as American women, because they don't have the same goals. I think that women should have equal rights because we are just as smart or smarter than men. For most OB/GYN problems, it is very important to balance the liver.

You seem to be saying that the more education women get and the more options they have, the more internal stress this creates. How is marriage different for Chinese women?

The whole social situation is different . There is less stress on women in one sense. Divorce is not popular. In my generation, women were virgins until marriage. This is changing, but when I was in medical school, we were not allowed to date, or we would be punished. Women just obey their husbands because they have a child, even if they don’t like their husband . They live with or near their in -laws, who watch the family. The husband can have other women, but the wife cannot have other men. Women also struggle with their emotions in these situations . They feel anxiety, sadness and anger that makes chi and blood stagnate. causing female problems and problems around pregnancy and delivery. Most marriages in china are OK, “so so”, not excellent, they argue but they stay together Now in China, women get the same educational opportunities as men. American women take better care of their health than Chinese women. American woman work out at the gym so their bodies can be stronger, because they work hard and they want to be successful. They have babies at a later age than in china. Educational level is a little higher than in China. Spleen and kidney problems are more prevalent here because American women are more open. They enjoy swimming and dancing they have a different way of dressing, young women wear tampons and keep their bodies looking fit. This is good, but they don't pay attention to taking care during the period.

During period time keep warmer, clean and don’t have sex, and keep emotions steady, if you get very sad your chi gets stuck and it causes pain. If you get cold your blood clots. No ice cubes, no ice cream, cold or raw food; so no spicy foods because it is too hot and can make worse a hot condition. For American women who are already stressed from their work and relationships, they enjoy sex anytime. Tampons are no good because they block circulation and can weaken the immune system, and increase risk of infection. Chinese women rest during menses and they use pads, no swimming , no bathing. When I worked as a county doctor I had the right to tell women to stay inside and not do outside work. During pregnancy, I recommend that women avoid sex for the first three months and then after that, only gently.

American practitioners have discovered that sex during the period can cause endometriosis. Why do the Chinese recommend no sex during the period?

The period depends upon the flow of liver chi and blood, kidney jing\chi, and Chong and Ren meridians. With menses, the Chong and Ren become full of blood and chi only if the kidney and liver are healthy; then the blood goes to the uterus. With a healthy period, there are no clots, little pain, no PMS. If you have sex during your period or if you get an internal exam during this time, this causes upward flow that can cause the endometrial lining and blood to go up toward the fallopian tubes, causing endometriosis. You can also get this after surgery such as a C-section.

In China, do you perform a laparoscopoy when a woman complains of pelvic pain?

First I ask the woman when the pain comes - with the period or ovulation or anytime? Is it in the lower abdomen, or where? We do palpation after the patient empties her bladder. If there is no menses, we do an internal check. Ultrasound is used alot. Often we find a solid mass or cyst. We treat with herbs first, then try laparoscopy if there is no improvement.

How do you treat uterine fibroids?

I am currently seeing a patient who has not been able to conceive for six years. Her tongue shows chi and blood stagnation. I did an internal check and felt her uterus was not moving properly. She had a little pain when I pushed up, and the uterus was the size of a two month pregnancy. There was a mass, not hard or soft, probably a fibroid tumor, located between the muscle. (There are three kinds - between the muscle, internal and outside the uterus.) This women works too hard. She has an excellent job and pushes herself too hard. So she has liver chi and blood stagnation, and low kidney energy. I am giving her acupuncture and herbal medicine.

Another patient I saw was pregnant with a fibroid. I worked together with a midwife. We took care of her and her delivery was fine. She had a baby girl! I did acupuncture and herbs prenatally. For a few months I went back and checked her. I treated kidney and moved chi and blood. Her fibroids are getting much smaller. During pregnancy, we don’t use acupuncture for the first three months. Later on I do use it, even if there is no problem, in order to balance the chi and blood, to balance the baby’s position and help avoid breech. During pregnancy, the fibroids tend to grow because of the increased hormones, so herbal treatment can help keep them from growing too much.

Do women have many abortions in China?

In China, population is a big problem. OB/GYN doctors have to do abortions by government order. I personally don’t like to do this because I believe the fetus is a life. In China, we have to do a few every week. The Chinese government limited one baby to one family. The government tells a family when they can try to get pregnant. We use IUDs and condoms in China. The IUD is very successful in China, very easy to use. Most Chinese women are responsible with birth control, but sometimes it fails. China enforce the use of birth control. They have a very tight net. In each hospital there is a special birth control department. They give you free birth control. After birth or abortion, they automatically insert an IUD.

In the US, there is not much population, and people do sex more freely. Especially inexperienced teenagers get alot of abortions. In the US., often people marry two or three time, and fall in love alot. So there is more chance for babies and accidents happen. American women get more abortions than Chinese women.

Why are abortions so hard on a woman’s body?

Abortion is surgery and the emotions are very painful. A women is a mother, is Yin. If they will have the baby, they will love it no matter what. If for some reason they decide not to have it, their emotions are hurt, the body is hurt. After abortions in the US, a woman is routinely given crackers and ice. After abortion, everything is open, the blood is loose, and it is very important for the women to take good care of herself: keep warm, eat easily digestible food, keep the emotions very steady. For most American women they do not take care with menses, after abortion, delivery or miscarriage. I need to talk with them: “Don’t eat too much spicy food, less sex please, no bath, rather shower, keep warm.”

Herb medicine is very popular in China. There is a 3000 year history. In the past, China wanted to promote population growth and did alot of research on how to promote a woman’s health, and deliver more babies. Many ancient books were written which are fascinating to read, and have not been translated into English. (She shows me a beautiful brocade-bound book which is 400 years old.) The Chinese were forced to open and share the traditional books and medical information. It is very difficult to translate these books. I like Bob Flaws’ contributions to translating some of these old books.

In your practice in China, when do you use herbs and acupuncture versus western medicine and surgery?

It depends on the situation. We use what is easier. For birth control, we don’t use herbal medicine, just IUD and condoms. For female menopause, we don’t like hormonal drug therapies. China does not use them much, and only in small dosage, very gentle. We might use them in combination with herbal medicine, and exercises to strengthen the body. In China I use 1/2 and 1/2 western and oriental medicine. For instance, I would use herbs for vaginal yeast infection, fallopian tube infection, irregular or delayed menses, etc. Morning sickness usually comes from weak stomach/spleen or stuck liver energy, (wood over earth.)

How do you treat threatened miscarriage?

If a woman starts to miscarry it is because there is chi, blood and kidney deficiency, or the liver is too hot, or perhaps she has fallen down and gotten hurt. In the case of when a woman has a fall and there is a little blood, check to see if the pulse is still slippery and strong. Look at the color of the blood. Are there clots being passed? Ask her what is hurting. How does she feel? The western treatment is to insert vitamin E vaginally and give sedative drugs. I use herbs to stop the bleeding. Usually kidney is weak and there is chi and blood deficiency. I recommend no raw food or spicy food, no sex, stay happy. If a woman cries very easily, her liver is unhappy. If there is a miscarriage, there is alot of cramping. If this can’t be avoided, we can use kidney tonic and blood circulating herbs including Chuanxiong, Toa Ren, Tang Quei, Shi Di Huang, Shen Di Huang, Gan Cao, MuXiang, Tu Si Zi, Dang Shen, and Du Zhong. Also we can add calming herbs. There are so many formulas, and you must be very flexible in prescribing.

What are some recommendations for pregnancy, labor and delivery?

During pregnancy we generally don’t use herbs which send Chi down or scatter the blood. Da Huang, Tao Ren, E Zhu, and Chuan Shan Jia are usually avoided. You need to be careful with Tang Quei and Chuan Xiong. With experience, you learn when these are appropriate and when they are not.

During labor and delivery we look at a woman’s bian zheng, her individual pattern. Most American women have stuck liver and weak kidney. We use alot of tonic herbs. I’ll give you an example of a 36 year old women I saw who was 8 months pregnant when she started to miscarry. (36 is young in America but old in China!) I gave her acupuncture and herbs and after a week she was OK. To make her labor easier, she continued to take herbs. I asked her about any history of females in her family who had problems with labor. She mentioned headaches which seem to be like a cold. This is from Chi deficiency and stuck liver Chi. You need to help the baby’s Chi (yang) follow the mother’s Chi (yin). I went to the hospital to help her with the delivery. During the delivery I gave her an herbal drink to balance the liver Chi and reduce pain. I use acupuncture for everybody for pain before, during and after labor. (I use such points as St 36, LI4, Liv 3 and San Liao pts.) Some time I use only a few, or just do massage; sometime I do more. You need to be very flexible. In China, we use a rectal suppository if the woman doesn’t like to drink herbs. After the birth, if there is alot of bleeding, maybe the placenta is not all out, or maybe the body is weak. I check the bleeding, I smell the blood. (If it smells like fish maybe there is infection.) I check the pulse, look at the stool, and look to see if the woman is sweating alot. If there is a problem with incomplete passage of the placenta or infection, don’t use tonic herbs. First use cooling and blood moving herbs to pass a big clot. Then later use tonic herbs. Then the patient gets well. It is important to focus on nourishing the blood. Sometimes we give Ren Shen. For diet, give easy to digest foods, soups, protein, pork feet with yellow beans and rice wine is good. Tell the woman to be happy, joyful.